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General NPI Number Information
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NPI Number | 1689080525
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Entity Type | Individual
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Provider Name | ERIC JOHNSON D.O.
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Gender | Male
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Dates
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Enumeration Date | 07/10/2014
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Last Update Date | 10/03/2022
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Provider Practice Location Address
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Address Line | 2580 SISTER MARY COLUMBA DR STE 200
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City | RED BLUFF
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State | CA
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Zip | 96080-4327
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Country | US
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Telephone | 530-528-6150
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Fax | 530-528-6196
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Provider Business Mailing Address
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Address Line | 3400 DATA DR
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City | RANCHO CORDOVA
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State | CA
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Zip | 95670-7956
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 19889
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License Number State | CA
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